PeaceHealth Southwest Medical Center and Clark County Public Health are advising 936 patients to be tested for hepatitis C.

A joint
investigation revealed that the patients might have been exposed to the
hepatitis C virus through the actions of a former PeaceHealth Southwest
employee suspected of diverting drugs for personal use. In certified
letters mailed May 19, the patients are urged to receive hepatitis C
testing at the expense of PeaceHealth Southwest.

Temporary patient service centers have been set
up in three locations to make the testing as convenient as possible. If
they choose, patients can be tested by their healthcare provider at
another location. Patients with questions are encouraged to visit www.peacehealth.org/HepC, send an email to HepC@peacehealth.org or call the patient care support line at (360) 729-2000 between 7 a.m. and 7 p.m., seven days a week.

A Long Island hospital says some
patients may be at risk of exposure to hepatitis B, hepatitis C and HIV
after authorities found that an insulin pen may have been used with more
than one patient.

South Nassau Community Hospital says
the risk of infection is extremely low but is nevertheless recommending
that patients get tested.

The hospital has sent a letter to over 4,000 patients, according to Newsday. It is offering free blood testing services and has set up a toll-free hotline that patients can call to schedule a blood test.

ST. PETERSBURG, Fla. — Patty Konietzky
thought the small purple lesion on her husband’s ankle was a spider
bite. But when the lesion quickly spread across his body like a
constellation, she knew something wasn’t right.

After a trip to the hospital and a day and a half later, Konietzky’s 59-year-old husband, Henry “Butch,” was dead.

The diagnosis — vibrio vulnificus, an
infection caused by a bacterium found in warm salt water. It’s in the
same family of bacterium that causes cholera.

The deadly effects from illicit version of the painkiller, however, stem
from the substances Forbes says “amateur chemists” don’t properly
remove.

Dr. Abhin Singala, a specialist at Presence St. Joseph Medical Center in
the Chicago suburb of Joliet, said he’s treating three people who took
“krokodil,” a cheap heroin knockoff from Russia known to cause such
extreme gangrene and abscesses that a user’s muscles, tendons and bones
can become exposed.

“As of late as last week, the first cases – a few people in Utah and Arizona – were reported to have been using the heroin-like drug, which rots the skin from the inside out,” Singala said in a Tuesday press release. “It is a horrific way to get sick. The smell of rotten flesh permeates the room. Intensive treatment and skin grafts are required, but they often are not enough to save limbs or lives.”

This warning is important for everyone especially those infected with hepatitis B and hepatitis C. Caution should be used with anything people are taking including prescribed medications, over-the-counter medications, herbs, supplements and vitamins. The key to staying healthy is to always work with your medical provider about what is safe to take and what should be avoided.

Another note of caution: People who are taking HIV or HCV protease inhibitors should not take St. johns wart – it can effect how well these drugs are absorbed into the bloodstream and ultimately affect successful treatment outcome.

Please visit the following links for more information on supplements and HCV:

Summary

Recently, a number of previously healthy individuals developed
acute hepatitis and sudden liver failure of unknown cause after using a
dietary supplement for weight loss or muscle building. CDC recommends
increased vigilance by public health agencies, emergency departments,
and healthcare providers for patients who develop acute hepatitis or
liver failure following use of a weight loss or muscle building
nutritional supplement. CDC requests that state health departments
report such occurrences to the CDC. CDC also recommends that, as part of
a comprehensive evaluation, clinicians evaluating patients with acute
hepatitis should ask about consumption of dietary supplements.

Background

On September 9, 2013, the Hawaii Department of Health (DOH) was
notified of seven patients with severe acute hepatitis and sudden liver
failure of unknown cause. The patients were previously healthy and
sought medical care from May through September 2013. Clinicians reported
that the seven patients had all used OxyELITE Pro, a dietary supplement
marketed for weight loss and muscle gain, prior to illness onset.
The investigation is ongoing and the data presented are preliminary.
Thus far, clinicians have reported 45 patients to the Hawaii DOH in
response to a public health alert. Of those, 29 patients, including the
original seven, were confirmed to have acute hepatitis after using a
nutritional supplement for weight loss or muscle building. The median
age of the 29 patients is 33 years; 14 (48%) are male. The date of the
first reported laboratory test was used as a proxy for illness onset and
ranged from May 10 through October 3, 2013. The most commonly reported
symptoms included loss of appetite, light-colored stools, dark urine,
and jaundice. Median laboratory values reported at the peak of illness
were the following:

aspartate aminotransferase (AST) 1,128 IU/L;

alanine transaminase (ALT) 1,793 IU/L;

alkaline phosphatase 150 IU/L; and

total bilirubin 12.6 mg/dL.

Ten patients had liver biopsy data available at the time of this
report. Seven had histology consistent with hepatitis from drug/toxic
injury, with findings including hepatocellular necrosis and cholestasis.
Three patients had liver biopsy findings of acute hepatitis associated
with other etiologies such as autoimmune hepatitis. Eleven (38%)
patients were hospitalized, with a median duration of seven days. One
patient died, and two patients received liver transplants. Two remain
hospitalized, and all other hospitalized patients have been discharged.
Of the 29 identified patients, 24 (83%) reported using OxyELITE Pro
during the 60 days prior to illness onset. There was no other dietary
supplement or medication use reported in common by more than two
patients.
National case finding efforts have identified several individuals
from states outside Hawaii with reported OxyELITE Pro or other weight
loss or muscle building dietary supplement use prior to the development
of acute hepatitis of unknown cause. CDC, in collaboration with state
health departments, is collecting additional clinical and epidemiologic
information from these individuals to determine if this outbreak is
national in scope.

Case definition

An individual with acute-onset hepatitis of unknown etiology that
developed symptoms on or after April 1, 2013 following use of a
non-prescription weight loss or muscle building dietary supplement
during the 60 days prior to illness onset.
With acute-onset hepatitis of unknown etiology defined as having BOTH:
– ALT > 4 times the upper limit of normal
– Total bilirubin > 2 times the upper limit of normal
AND
-negative workup for infectious or other explicative etiologies for
hepatitis. Workup for other potential etiologies should include:

– No recent hypotensive shock or septic episodes – No history of alcoholism documented in medical records

Recommendations

Clinicians evaluating patients with acute hepatitis should ask about
consumption of dietary supplements as part of a comprehensive
evaluation.

Clinicians should report patients meeting the case definition to the
local or state health department, as well as the US Food and Drug
Administration’s MedWatch program online at https://www.accessdata.fda.gov/scripts/medwatch/ or by phone at 1-888-INFO-FDA.

People who use dietary supplements for weight loss or muscle gain
should do so with caution and under a medical provider’s close
supervision.

For more information

State public health agencies should contact CDC at (866) 933-5295 if they identify patients who meet the case definition.

The Centers for Disease Control and Prevention
(CDC) protects people’s health and safety by preventing and controlling
diseases and injuries; enhances health decisions by providing credible
information on critical health issues; and promotes healthy living
through strong partnerships with local, national, and international
organizations.

Info Service: Provides general information that is not necessarily considered to be of an emergent nature. Example: HAN00345

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This message was distributed to state and local health officers,
state and local epidemiologists, state and local laboratory directors,
public information officers, HAN coordinators, and clinician
organizations.
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